A High-Level Athlete With Tachycardia-Induced Cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Tachycardia-induced cardiomyopathy secondary to ectopic atrial tachycardia (n=1). Intervention: Medical therapy (ivabradine, sacubitril/valsartan, nadolol, flecainide) and repeat catheter ablation (irrigated radiofrequency followed by cryocatheter ablation). Primary outcome: Resolution of ectopic atrial tachycardia and recovery of left ventricular systolic function.

Q: What does this research mean for the field?

Catheter ablation of right-atrial appendage tachycardia successfully eliminates arrhythmia and reverses ventricular systolic dysfunction in athletes with tachycardia-induced cardiomyopathy, enabling safe return to competitive sports. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

William W. Russell; Joseph Rossano; Stephen Paridon; Paul Stephens; Julie A. Brothers; Chandra Srinivasan; Jonathan B. Edelson

doi:10.1016/j.jaccas.2026.107155

March 1, 2026JACC Case ReportsOpen Access

A High-Level Athlete With Tachycardia-Induced Cardiomyopathy

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Why the study?

Pediatric athletes with tachycardia and ventricular dysfunction are often assumed to have dilated cardiomyopathy or myocarditis, but a broad differential diagnosis should be maintained.

Key Points

To describe the diagnostic evaluation and management of an 18-year-old competitive athlete presenting with unexplained resting tachycardia and left ventricular systolic dysfunction.
Clinical evaluation of an 18-year-old competitive athlete who presented to the emergency room with chest pain and nonexertional heart rates ranging from 120 to 200 bpm.
Workup included 12-lead electrocardiography, echocardiography, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, infectious myocarditis panels, and exome sequencing.
Therapeutic interventions comprised medical therapy (ivabradine, sacubitril/valsartan, nadolol, and flecainide), followed by electrophysiological mapping, radiofrequency catheter ablation, and repeat cryocatheter ablation.
Initial echocardiography demonstrated diminished left ventricular systolic function with normal dimensions (left ventricular internal dimension in diastole 5.3 cm, Z-Score -0.5), while infectious panels and exome sequencing were negative.
Electrophysiology mapping localized ectopic atrial tachycardia to the right-atrial appendage; cardiopulmonary exercise testing revealed conversion from atrial tachycardia at rest to sinus rhythm during exertion.
Arrhythmia focus elimination was achieved with cryocatheter ablation, resulting in fully recovered left ventricular systolic function (cardiac MRI ejection fraction 52% during sinus beats) and safe return to competitive athletics.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 18-year-old male competitive athlete presenting with ectopic right-atrial appendage tachycardia and moderately diminished left ventricular systolic function.

I

Intervention

Initial medical therapy with ivabradine and sacubitril/valsartan (24-26 mg, later increased to 49-51 mg twice daily), followed by irrigated radiofrequency catheter ablation of the anterolateral right-atrial appendage, interim nadolol and flecainide, and subsequent cryocatheter ablation of the medial aspect of the right-atrial appendage.

O

Outcome

Elimination of the ectopic atrial tachycardia focus, normalization of left ventricular systolic function, and safe return to competitive sports participation.

Limitations

Single-patient case report

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Implication

Tachycardia-induced cardiomyopathy secondary to right-atrial appendage ectopic atrial tachycardia is a subtle but reversible cause of ventricular dysfunction in young athletes that can masquerade as sinus tachycardia and be successfully treated with catheter ablation to allow safe return to sports.

Abstract

BACKGROUND: Pediatric athletes with tachycardia and ventricular dysfunction are often assumed to have dilated cardiomyopathy or myocarditis, but a broad differential should be maintained. CASE SUMMARY: An 18-year-old competitive athlete presents to the emergency room with tachycardia and chest pain. Electrocardiogram was thought to show high right-atrial tachycardia consistent with sinus tachycardia, and echocardiogram demonstrated diminished left ventricular systolic function without dilation. Viral myocarditis and cardiomyopathy genetic testing were negative. Further observation and workup demonstrated ectopic atrial tachycardia, which was treated, and the patient returned to sports. DISCUSSION: Tachycardia-induced cardiomyopathy is a rare, but reversible, cause of tachycardia and ventricular dysfunction. Exercise stress test can be useful in risk stratification. If returning to sport activity, an emergency action plan must be discussed with the patient and athletic training staff. TAKE-HOME MESSAGE: Tachycardia-induced cardiomyopathy can be a subtle diagnosis but should not be missed, as this disease can be reversible with appropriate treatment.

Discussion

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Cite This Study

Russell et al. (2026) conducted a case report in Tachycardia-induced cardiomyopathy secondary to ectopic atrial tachycardia (n=1). Medical therapy (ivabradine, sacubitril/valsartan, nadolol, flecainide) and repeat catheter ablation (irrigated radiofrequency followed by cryocatheter ablation) was evaluated on Resolution of ectopic atrial tachycardia and recovery of left ventricular systolic function.

synapsesocial.com/papers/69c770418bbfbc51511e0750 https://doi.org/10.1016/j.jaccas.2026.107155

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A High-Level Athlete With Tachycardia-Induced Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A High-Level Athlete With Tachycardia-Induced Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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